Special Populations

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Sexual assault is a major problem faced by homeless women, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08323). Recent interviews with nearly 1,000 homeless women in Los Angeles County revealed that 13 percent of the women had been raped during the previous year, and half of these women were raped at least twice in that year. The women ranged in age from 15 to 44 years and completed a 45-minute structured interview seeking to correlate factors with rape among these women.

Results from the interviews showed that compared with homeless women who had not been raped, rape victims were three times as likely (odds ratio, OR 3.3) to have one or more limitations in their ability to function physically, nearly twice as likely (OR 1.88) to report two or more gynecologic symptoms and conditions, and three times (OR 3.31) as likely to report two or more serious physical health symptoms. Rape victims were also more apt than women who had not been raped (53 vs. 35 percent) to report that they had not seen a doctor during the previous year, despite their need to do so. In addition, rape victims were nearly three times as likely as nonvictims to have experienced psychological distress during the past month (OR 2.68) and depression during the past year (OR 2.87) and twice as likely to have a lifetime history of alcohol (OR 1.83) or drug (OR 2.46) abuse or dependence. What's more, homeless women who were raped were more likely than those who hadn't suffered rape to say they desired treatment for substance abuse but were unable to obtain it (20 vs. 6 percent).

These results should serve to alert clinicians about groups of homeless women who may benefit from rape screening and treatment interventions. The striking association of rape with all aspects of women's health suggests that all homeless women who present with serious mental, physical, or substance abuse problems should be screened for violent experiences, notes Lillian Gelberg, M.D., M.S.P.H., of the University of California, Los Angeles.

See "Health of homeless women with recent experience of rape," by Suzanne L. Wenzel, Ph.D., Barbara D. Leake, Ph.D., and Dr. Gelberg, in the April 2000 Journal of General Internal Medicine 15,
pp. 265-268.